Provider Demographics
NPI:1316017007
Name:HEPPERLEN, CHRISTINE C (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:HEPPERLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E TERRA COTTA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3621
Mailing Address - Country:US
Mailing Address - Phone:815-356-2323
Mailing Address - Fax:815-455-8130
Practice Address - Street 1:750 E TERRA COTTA AVE STE B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3621
Practice Address - Country:US
Practice Address - Phone:815-356-2323
Practice Address - Fax:815-455-8130
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003490363L00000X
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK33845214660Medicare PIN